Medicare Administrative Costs: Hearings Before the Subcommittee on Oversight of the Committee on Ways and Means, House of Representatives, Ninety-fourth Congress, Second Session, August 2 and 27, 1976 |
From inside the book
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Page 1
... claims . At a time when health insurance costs are skyrocketing to cata- strophic heights , I find it shocking that these intermediaries - most of which are nonprofit , tax - exempt , Blue Cross plans - would have any luxury ...
... claims . At a time when health insurance costs are skyrocketing to cata- strophic heights , I find it shocking that these intermediaries - most of which are nonprofit , tax - exempt , Blue Cross plans - would have any luxury ...
Page 7
... claims against BCA dating from 1971 , " $ 49,000 for first - class air fare over tourist ; $ 322,000 for incorrect salary allocation . " Did they just feel that they might as well try it and if you didn't catch it , it would go through ...
... claims against BCA dating from 1971 , " $ 49,000 for first - class air fare over tourist ; $ 322,000 for incorrect salary allocation . " Did they just feel that they might as well try it and if you didn't catch it , it would go through ...
Page 9
... claims in Florida , we noted that one apparent cause of a high turn over of medicare claims examiners was that they were paid less than claims examiners in other parts of the carrier's organization . The test of reasonableness would be ...
... claims in Florida , we noted that one apparent cause of a high turn over of medicare claims examiners was that they were paid less than claims examiners in other parts of the carrier's organization . The test of reasonableness would be ...
Page 11
... claims processing and paying agents under agreement with the Secretary , HEW . Currently , there are 130 medicare contractors subject to our audits , including 74 Blue Cross organizations , 32 Blue Shield plans , 23 com- mercial ...
... claims processing and paying agents under agreement with the Secretary , HEW . Currently , there are 130 medicare contractors subject to our audits , including 74 Blue Cross organizations , 32 Blue Shield plans , 23 com- mercial ...
Page 12
... claimed expenses are supported by the books and records and make comparisons of claimed costs , in total and by line item , to approved budgets and the prior year cost report . These overall checks are preliminary to the selection of ...
... claimed expenses are supported by the books and records and make comparisons of claimed costs , in total and by line item , to approved budgets and the prior year cost report . These overall checks are preliminary to the selection of ...
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Common terms and phrases
activities administrative costs agree agreement allocation amount Article BCA's bill Blue Cross Association Blue Cross Plans Blue Shield budget Bureau of Health carrier changes charge claims processing committee contract Cost Accounting Standards cost reports data processing determined effective established evaluation executive executive compensation Federal Health Insurance Federal Procurement Regulations fiscal functions and duties funds Government Health Insurance Benefits HEW Audit hospital implementation increase instructions Insurance Benefits Account Intermediary issues letter of credit mediary Medicaid Medicare program ment million negotiation operations organization paragraph payment percent performance physicians Plan's prior approval private sector problems procedures proposed providers of services pursuant question records regional offices reimbursement responsibility role Secretary Social Security Act Social Security Administration specific staff STARK STEPNICK submit Suycott term termination TIERNEY tion TRESNOWSKI utilization review vice president Wisconsin
Popular passages
Page 220 - Contractor shall proceed diligently with the performance of the contract and in accordance with the Contracting Officer's decision. (b) This "Disputes" clause does not preclude consideration of law questions in connection with decisions provided for in paragraph (a) above : Provided, That nothing in this contract shall be construed as making final the decision of any administrative official, representative, or board on a question of law.
Page 174 - The decision of the Secretary or his duly authorized representative for the determination of such appeals shall be final and conclusive unless determined by a court of competent Jurisdiction to have been fraudulent, or capricious, or arbitrary, or so grossly erroneous as necessarily to imply bad faith, or not supported by substantial evidence.
Page 199 - Disputes" clause of this contract, (2) litigation or the settlement of claims arising out of the performance of this contract, or (3) costs and expenses of this contract as to which exception has been taken by the Comptroller General or any of his duly authorized representatives, shall continue until such appeals, litigation, claims, or exceptions have been disposed of.
Page 216 - Defense to procure supplies and services from responsible sources at fair and reasonable prices calculated to result in the lowest ultimate overall cost to the Government.
Page 199 - Contractor shall be afforded an opportunity to be heard and to offer evidence in support of its appeal. Pending final decision of a dispute hereunder, the Contractor shall proceed diligently with the performance of the contract and in accordance with the Contracting Officer's decision. b. This "Disputes" clause does not preclude consideration of law questions in connection with decisions provided for in paragraph a.
Page 223 - I know his signature, and his signature thereto is genuine; and that said bond was duly signed, sealed, and attested for and in behalf of said corporation by authority of its governing body. ["Corporate"!
Page 182 - Except as otherwise provided in this contract, any dispute concerning a question of fact arising under this contract which is not disposed of by agreement shall be decided by the Contracting Officer, who shall reduce his decision to writing and mail or otherwise furnish a copy thereof to the Contractor.
Page 134 - ... by providers of services and other persons to individuals entitled to benefits under this part, and provide procedures for and assist in arranging, where necessary, the establishment of groups outside hospitals (meeting the requirements of section...
Page 177 - States or any of his duly authorized representatives shall, until expiration of 3 years after final payment under this contract, or of the time periods for the particular records specified in Part 1-20 of the Federal Procurement Regulations (41 CFR Part 1-20), whichever expires earlier, have access to and the right to examine any directly pertinent books, documents, papers, and records of the Contractor involving transactions related to this contract.
Page 219 - ... or of the time periods for the particular records specified in Part 1-20 of the Federal procurement regulations (41 CFR Part 1-20), whichever expires earlier, have access to and the right to examine any directly pertinent books, documents, papers, and records of such subcontractor, involving transactions related to the subcontract. The term "subcontract...